Intermittent catheterization of the bladder with tetraplegia due to spinal cord injury

Aim. Identify ways of urinary diversion and factors affecting the use of intermittent catheterization in patients with tetraplegia. Materials and methods. 31 patients participated in the examination with tetraplegia, under rehabilitation in Rehab center "Preodolenie" in 2017–2018, with neurological level corresponding to the C4–D1 segments of the spinal cord. All patients were assigned intermittent bladder catheterization, based on urodynamic examination data. Patients with an intact plucking of the fingers were engaged with the ergotherapist in mastering the skill of performing bladder catheterization on their own. 6 (12) months after discharge from the in-patient facility, patients were questioned by phone using the Neurogenic Bladder Symptom Score (NBSS). These data were compared with the conclusion of the ergotherapist and the results of a retrospective neurological examination (American Spinal Injury Association Neurological Standard – ASIA). Results. At the time of the survey, patients had urinary reflex urination with the prevailing methods of urine discharge – 39% (category D on the NBSS scale) and periodic catheterization (category C on the NBSS scale) – 32%. The only factor affecting the popularity of intermittent catheterization is the presence of the skill of its implementation directly by the patient (correlation coefficient R=0.86), which in turn depends only on the completeness of damage to the spinal cord (ASIA 1.20 vs 1.14; p=0.04); the quality of life of patients with neurogenic impaired urination was higher with an incomplete type of damage (C and D types according to ASIA; criterion F=3.1; p=0.04). Conclucion. Among the factors affecting the adherence of patients to the prescribed method of urine discharge, the skill of self-fulfillment and social reasons associated with the complexity of organizing the implementation of intermittent catheterization of the bladder at home is of paramount importance